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Get Michigangovemployer Report Of Injury Form
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How to fill out the Michigangovemployer Report Of Injury Form online
Filling out the Michigangovemployer Report Of Injury Form is a critical step in reporting workplace injuries. This guide will provide clear, step-by-step instructions to help you complete the form efficiently and accurately.
Follow the steps to fill out the form correctly
- Click ‘Get Form’ button to access the form and open it in the editor.
- Begin with Section I: Employee Data. Enter the employee's Social Security number, name (last and first), date of injury, address (including city, state, and ZIP code), date of birth, number of dependents, sex, and telephone number. Ensure that all information is accurate and complete.
- Proceed to Section II: Employer/Carrier Data. Fill in the employer's name, federal ID number, injury and mailing location codes, and UI number. Also, provide the employer's street address, city, state, and ZIP code. If applicable, include the insurance company name and telephone number.
- Move to Section III: Injury/Medical Data. Indicate the last day the employee worked and the date they returned to work (if applicable). Answer whether the employee died and provide the date of death if applicable. Also, state the location of the injury, the nature of the injury, how the injury occurred, and any other relevant medical details.
- In Section IV: Occupation and Wage Data, provide the date hired, total gross weekly wage, and number of weeks used. Specify the employee's occupation and whether they were a volunteer worker. Include if the employee was certified as vocationally handicapped.
- Complete Section V: Preparer Data. Enter your name, signature, telephone number, and the date the form was prepared. Remember to certify that a copy of this report has been given to the employee.
- Finally, review all entries for accuracy and completeness. Once verified, you can save changes, download, print, or share the completed form as needed.
Take the next step in managing workplace safety by completing the Michigangovemployer Report Of Injury Form online.
â– How Long Do I Have To File A Claim The statute states that you should provide notice of injury to the employer within 90 days of the injury. However, you have up to two years from the date of injury, or the date the disability manifests itself, to file a workers' compensation claim.
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